I haven't had time to think through an intelligent response to this issue yet, but here is a press release from the AIDS Task Force of Greater Cleveland. Maybe this will spark some dialogue.
FOR IMMEDIATE RELEASE
Contact: Earl Pike, CEO, AIDS Taskforce of Greater Cleveland
3210 Euclid Avenue, Cleveland, OH 44115
epike@atfgc.org; 216-357-2221
Follow-up: Additional Reactions to Swiss Study
Cleveland, Ohio (February 4, 2008) — Last week the AIDS Taskforce of Greater Cleveland issued a press release urging a continued commitment to safer sex after Swiss HIV experts issued a consensus statement concluding that “an HIV-infected person on antiretroviral therapy with completely suppressed viraemia (“effective ART”) is not sexually infectious, i.e. cannot transmit HIV through sexual contact.” [Emphasis ours]
Scientists and advocates have begun weighing in on the study. Here are some of their reactions.
? From the Terrence Higgens Trust (THT), the lead HIV/AIDS agency in the UK: “This is a controversial statement that does not reflect the views of most doctors. The scientific evidence is incomplete, so we can’t suggest that transmission is impossible for people whose treatment is working well. We have known for a long time that successful treatment does reduce the risk, but we also know that the level of the virus in the body can go up between medical visits.” A THT spokesperson also expressed concern that the “real thing” missing from the report was information about “anal sex and getting a new” sexually transmitted infection.
? From the French National AIDS Council: “the findings are not conclusive enough to apply to all HIV-positive people who follow their treatment regimens.”
? From Michael Lederman, MD, Director of the Center for AIDS Research at Case Western Reserve University (from an e-mail): “ . . . it is very difficult to draw any conclusions other than the risk of HIV infection diminishes when the levels of virus in plasma (and presumably genital secretions) are low . . . I suspect that the risks are in fact very low for transmitting HIV from a HAART-treated person with VL<50/mL to his partner, I think we don’t have enough good data to know how low it is.”
The AIDS Taskforce continues to conclude that while this may be good news for population-based strategies to reduce HIV transmission, the need for safer sex, including consistent use of latex condoms, is not diminished.
# # #
Yesterday’s Press Release from the ATGC:
AIDS Taskforce Responds to Swiss Medical Consensus Statement on HIV Transmission
Taskforce Urges Continued Commitment to Safer Sex, Condoms
Cleveland, Ohio (January 31, 2008) — Yesterday Swiss HIV experts issued a consensus statement concluding that “after review of the medical literature and extensive discussion,” the Swiss Federal Commission for HIV / AIDS resolves that, “An HIV-infected person on antiretroviral therapy with completely suppressed viraemia (“effective ART”) is not sexually infectious, i.e. cannot transmit HIV through sexual contact.”
The statement is published in this week’s Bulletin of Swiss Medicine (Bulletin des médecins suisses), and was authored by four of Switzerland’s foremost HIV experts.
The report goes on to say that the concluding statement is valid as long as 1) the individual adheres to antiretroviral therapy, the effects of which must be evaluated regularly by the treating physician; 2) the individual’s viral load has been suppressed (< 40 copies/ml) for at least six months; and 3) there are no other sexually transmitted infections (STIs).
The article begins by stating that the Commission “realizes that medical and biologic data available today do not permit proof that HIV-infection during effective antiretroviral therapy is impossible, because the non-occurrence of an improbable event cannot be proven. If no transmission events were observed among 100 couples followed for two years, for instance, there might still be some such events if 10,000 couples are followed for ten years. The situation is analogous to 1986, when the statement ‘HIV cannot be transmitted by kissing’ was publicized. This statement has not been proven, but after 20 years’ experience its accuracy appears highly plausible.”
The AIDS Taskforce of Greater Cleveland expressed concern about the limitations and implications of the study today, noting both positive and potentially negative aspects of the statement.
“On the one hand, the Swiss statement reinforces a growing body of evidence that affirms the importance of effective treatment as a prevention strategy,” said Earl Pike, executive director of the AIDS Taskforce. “Improving access and adherence to antiretroviral medication will help reduce HIV transmission in populations.”
But there is still a long way to go before universal access and adherence is achieved, and “populations are not the same as individuals,” Pike cautioned. “Those are stringent criteria to meet, and individuals, in making personal decisions, should still practice safer sex by using condoms and other latex barriers. A key proposition in HIV prevention has been, ‘unless you know for sure, you should practice safer sex.’ And individuals will still not know for sure.”
“It is absolutely critical that communities and individuals continue the commitment to consistent condom use,” Pike concluded.
The Swiss statement arrives at the same conclusion, asserting that prevention campaigns in Switzerland—promotion of condoms for all sexually active adults—should not change.
2 comments:
Good for the Swiss, I say. They are not determined to treat the general public as dunces (as AIDS Inc) seems determined to do.
More thoughts with all the background and data for anyone who wants to make a properly informed choice at:
http://www.wisdomofwhores.com/2008/02/05/to-inform-or-to-overprotect-the-swiss-have-chosen-well/
Well, I couldn't have called that one any closer. I'm not shocked by the opposition to the Swiss study, but I am shocked and, quite frankly, disappointed by the anti-research and anti-science approach that service providers and agencies are taking. I know the stakes are high. However, the Swiss report is based on scientific research that is really no different than any other scientific research. Those scientists have an obligation and a responsibility to put those findings out there. They are very clear about their methodology, and they are very clear about what they think their finding mean. Research findings can always be misinterpreted and misapplied, but to suggest that those findings should not be made public because of the potential or possibility of that happening is ludicrous. Research should influence. It should influence further research, policy, practice, and social change. Also, you can't attack scientific research for what it didn't do as long as the parameters and methodology of the study are clearly stated. Honestly, the more I've read the responses to the report, the more I wonder what report they actually read.
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